What to Expect When You Have an Extremely Premature Infant
Infants born between 22 and 26 weeks of pregnancy are called "extremely premature." If your infant is born this early, you likely will face some hard decisions.
Your premature infant has a much greater chance than ever before of doing well. A baby has the best chance of survival in a neonatal intensive care unit (NICU) that has a staff with a lot of experience.
Your infant may not respond well to attempts to keep him or her alive. Often it's not clear whether treatment will help an infant live—with or without disability—or will only make the dying process take longer. A specialist called a neonatologist can give you some idea of what may happen. But no one can predict what exactly willhappen. In the end it will be up to you to decide how far to continue treatment.
Having a premature baby may be stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual adviser, a counselor, or a social worker. You may be able to find a support group of other parents who are going through the same thing.
What can you expect after an extremely premature birth?
If the baby can't breathe, the first decision that may be faced by parents and doctors is whether to resuscitate the infant. This means bringing the baby alive by getting the heart and lungs to work.
Most doctors will try to resuscitate the baby. But experts support the decision to not resuscitate if:1
- The baby was born after a pregnancy of less than 23 weeks.
- The baby weighs less than 400 g (0.9 lb).
Very few infants survive when they are born at 22 to 23 weeks of pregnancy. Most of these babies get care that makes them comfortable instead of treatment to keep them alive.
Some doctors recommend trying to revive all 24- to 25-week newborns and then deciding on further treatment based on how well an infant responds.
Treatment decisions are usually based on whether the infant's brain has been damaged. This can happen from bleeding in the brain or a lack of oxygen. An ultrasound can find this type of damage.
The first month after the birth is when most major problems occur. It is a critical decision-making period for parents. There may be laws in your area that affect your decisions. Talk to your doctor about this.
How many of these babies survive being born?
Research shows that although many babies do survive extremely premature birth, many others do not. And the more premature the baby is, the lower the chances of survival are. The table below shows the results of two studies with similar results.
Weeks of pregnancy
2 to 3 out of 10 survived (7 to 8 out of 10 died)
5 out of 10 survived (5 out of 10 died)
Nearly 8 out of 10 survived (about 2 out of 10 died)
It's important to remember that research results are only general numbers. Everyone's case is different, and these numbers may not show what will happen in your baby's case.
How many of these babies have problems later on?
Many problems can't be found until after an infant's more urgent problems are under control. For example:
- The risk for cerebral palsy can be estimated no sooner than 28 days after birth, when certain patterns of brain damage can be checked by ultrasound or MRI.
- Learning disabilities are often not found until the early school years.
- Behavioral problems such as attention deficit hyperactivity disorder (ADHD) may not be noticed until the child is older.
Below are examples from studies of children who survived being born extremely early. Researchers looked at how likely these children were to have problems later on, based on how early they were born and/or what they weighed at birth.
Weeks of pregnancy, or birth weight
Number of infants who had problems later on
Less than 25 weeks, or weight of 750 g (1.7 lb) or less
Weight of 500 g (1.1 lb) to 800 g (1.8 lb)
About 3 out of 10 had one or more of the problems listed above.1 This means that about 7 out of 10 did not get these problems. But those 7 were still more likely than other children to have a learning disability, attention problems, and behavior problems.4
25 to 26 weeks
Nearly 4 out of 10 had problems at age 19, including problems with hearing, sight, intellectual disability, and having a job.5 This means that more than 6 out of 10 did not have these problems.
In the first year of life, babies that have a very low birth weight are more likely to be in the hospital more often than babies who were born at a healthier weight.3
- MacDonald H, Committee on Fetus and Newborn (2002). Perinatal care at the threshold of viability. Pediatrics, 110(5): 1024–1027.
- Tyson JE, et al. (2008). Intensive care for extreme prematurity—Moving beyond gestational age. New England Journal of Medicine, 358(16): 1672–1681.
- Stoll BJ, Adams-Chapman I (2007). Prematurity and intrauterine growth retardation section of The high-risk infant. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 701–710. Philadelphia: Saunders Elsevier.
- Bhutta AT, et al. (2002). Cognitive and behavioral outcomes of school-aged children who were born preterm. JAMA, 288(6): 728–737.
- Hille ETM, et al. (2007). Functional outcomes and participation in young adulthood for very preterm and very low-birth-weight infants: The Dutch project on preterm and small for gestational age infants at 19 years of age. Pediatrics. Published online August 31, 2007 (doi:10.1542/peds.2006-2407).
Other Works Consulted
- Committee on Fetus and Newborn, American Academy of Pediatrics (2007). Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 119(2): 401–403. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;119/2/401.pdf.
- Pignotti MS, Donzelli G (2008). Perinatal care at the threshold of viability: An international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics, 121(1): e193–e198.
|Editor||Susan Van Houten, RN, BSN, MBA|
|Associate Editor||Pat Truman, MATC|
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Kimberly Dow, MD, FRCPC - Neonatology|
|Last Updated||May 22, 2009|
Last Updated: May 22, 2009